Individuals who receive hearing aids or other assistive listening devices are often dissatisfied with the limited benefits they receive, and experience particular difficulty when listening in the presence of background noise. We envision that someday the majority, if not all patients who receive a hearing aid (or cochlear implant), wil also participate in a well-validated program of auditory training (AT), one that teaches them to extract meaning from the speech signal and to listen more successfully in noise. In our first grant cycle, our interdisciplinary research team conducted one of the first large-scale, systematic evaluations of the efficacy of AT for adult hearing aid users. We found that meaning-based AT, which is based upon principles of second language learning, leads to substantial improvements in listening and in everyday communication interactions, and that these improvements are maintained for at least 3 mos following training. One of the most innovative aspects of this work was that it examined the extent to which training gains were maintained over the long term. Although some improvements were maintained 12 mos post training, declines were observed relative to immediate post-training assessments. The success of our meaning-based AT program has motivated the current proposal in which we propose to study whether we can maintain AT benefits for up to 24 mos post- training in adults who have hearing loss and to determine whether meaning-based AT is also beneficial for school-aged children who use either hearing aids or cochlear implants. We also propose to establish whether the reduced encoding demands resulting from AT improve individuals' ability to benefit from the addition of visual speech information (i.e., visual enhancement). In the first specific aim, 100 adults will receive 12 hrs of AT and then receive either additional spaced or massed sessions of AT prior to their 12-mo test session. Current findings in cognitive psychology and learning theory suggest that spaced training will be more effective than massed training in preventing the declines in training benefit that we have noted at 12 mos, and that both types of booster training will prevent the declines seen relative to the 50 participants from our first grant cycle.In the second specific aim, we propose to determine the extent to which meaning-based AT improves the listening skills of 40 school-aged children as compared to a compatriot control group. We will relate benefits to predictor variables that include working memory, language skills, and degree of hearing loss. Finally, the third specific aim will determine the extent to which both adults and children improve their visual enhancement following AT, and will relate any improvements to changes in perceptual effort. Bringing together experts from the fields of aural rehabilitation, second language acquisition, and cognitive psychology, this translational research project represents a unique opportunity to apply theoretical principles of cognitive psychology and second language learning to develop effective AT procedures for both adults and children and to research how training in the auditory realm may enhance individuals' utilization of a visual speech signal. PUBLIC HEALTH RELEVANCE: Most children and adults who have hearing loss experience great difficulty in listening to speech in noisy environments. In our first grant cycle, we developed a meaning-based auditory training program (I Hear What You Mean) and demonstrated that it led to improved speech recognition in adults. In this renewal grant cycle, we propose to compare the extent to which a spaced versus massed auditory training booster program maintains and enhances training gains, to determine the extent to which a meaning-based auditory training program benefits school-aged children and to identify participant variables that predict benefit, and to determine the extent to which auditory training improves the visual enhancement of both children and adults and reduces perceptual effort.